The standoff between the Ministry of Health and private hospitals over money owed to them by the Social Health Authority (SHA) and the defunct National Hospital Insurance Fund (NHIF) is threatening to plunge Kenya's healthcare system into a full-blown crisis.
With healthcare providers refusing to treat patients until their claims are settled, the lives of millions of Kenyans now hang in the balance, as access to essential medical services becomes increasingly limited.
During a closed-door meeting with the Ministry of Health on Tuesday, the Chairperson of the Rural Urban Private Hospitals Association (RUPHA) Dr Brian Lishenga, revealed that the ministry had no available funding or immediate plans to settle outstanding payments to hospitals.
"No progress was made during the discussions. The ministry made it clear that there is no available funding and no immediate plans to settle the outstanding payments to hospitals," Dr Lishenga said.
However, according to Ministry of Health Principal Secretary for Medical Services Harry Kimtai, they are aware of the claims that were incurred by the defunct NHIF and that SHA will continue to pay all the undisputed debts.
The Social Health Authority building, Nairobi in this picture taken on October 6, 2024.
Photo credit: Lucy Wanjiru | Nation Media Group
He said that undisputed Sh19 billion NHIF claims were identified in a September 2023 report, and so far, Sh9 billion has been paid, leaving a balance of Sh10 billion.
“We encourage private health facilities to continue providing our beneficiaries with services focusing on a comprehensive approach to cushion people from financial hardship to achieve the government agenda of making healthcare available and affordable to all Kenyans,” the PS said.
Mr Kimtai urged health facilities to track their claims by going to the provider portal. He said that all the invoices and the claim status are on the portal.
“This will enable them to know the status of their claims and whether they are being processed or not,” he said.
However, healthcare providers are adamant that they will not treat any patients under SHA until the debts are cleared.
"Our position was clear, any undisputed claims should be paid immediately. The ministry’s response? There is no money. The government cannot commit to what it doesn't have," Dr Lishenga said, adding that with no payment plan in sight, there will be dire consequences.
"Hospitals are struggling. If this continues, we will lose more lives. The health sector requires the government's urgent attention. This is not a matter of negotiation, healthcare is a national public good. If the government truly values the lives of Kenyans, it must act now.
“It looks like this SHA thing was a cash cow. It is not for the good of Kenyans. If people’s health is important, the money will be found.”
Will the government prioritise healthcare, or will Kenyans continue to suffer as hospitals close their doors? This is the question on many Kenyans’ minds.
While the ministry insists that 100 per cent of SHA claims are being paid, healthcare providers strongly disagree.
Dr Lishenga said at least 48 per cent of health providers have indicated that the payment they have received does not match the ministry's claims.
“We demand that SHA publishes a detailed breakdown of payments made to hospitals. They are misleading Kenyans. Hospital owners are not receiving money. So, who exactly are they paying?" He asked.
Dr Lishenga said that hospitals are grappling with a mountain of debt inherited from NHIF, further worsened by SHA's delayed payments. The health providers argued that the small amount of money disbursed by SHA is insufficient to cover operational costs, leaving many hospitals on the brink of closure.
"It is non-negotiable — the government must settle NHIF liabilities immediately. We cannot continue providing services without a clear payment plan. It is either you prioritise this or we will not give any services.
"If the government previously released Sh9 billion, why can't the same be done now? What changed? This is a national priority—lives are at stake. Where did they get the money then that they cannot get now?”
Dr Lishenga said there is a need to set up a dispute tribunal so that in case health providers and SHA do not agree on the payment, then the issue is taken to the panel, adding that it is not possible for all hospitals to have a meeting with the PS.
"It is impossible for all hospitals to meet with the Principal Secretary. We need a formal tribunal to address these payment disputes," he said.
On Monday, over 600 facilities affiliated with RUPHA suspended SHA services across the country.
Rupha leadership issued guidelines to hospitals reminding them to only offer emergency services and treat patients who were already signed up before their directive. Non-emergency patients registered under SHA, as well as teachers and police officers who use the Medical Administrator Kenya Limited, will not be attended to unless they have alternative modes of payment.
